Impact of Chemotherapy in the Adjuvant Setting of Early Stage Uterine Leiomyosarcoma: A Systematic Review and Updated Meta-Analysis

Background: Although the use of adjuvant chemotherapy (AC) appears to be increasingover the past few years, several clinical trials and previous meta-analyses failed to determine whetherAC could improve clinical outcomes in uterine leiomyosarcoma (uLMS). The aim of this systematicreview and meta-analysis was to compare AC (with or without radiotherapy) versus observation(obs) after primary surgery in early stage uLMS. Materials and Methods: Randomized controlled(RCTs) and non-randomized studies (NRSs) were retrieved. Outcomes of interest were as follows:distant recurrence rate, locoregional recurrence rate and overall recurrence rate. Results about distantrecurrence rate, locoregional recurrence rate and overall recurrence rate were compared by calculatingodds ratios (ORs) with 95% confidence intervals (CIs); ORs were combined with Mantel–Haenszelmethod. Results: Nine studies were included in the analysis, involving 545 patients (AC: 252,obs: 293). Compared with obs, AC did not reduce locoregional and distant recurrence rate, with apooled OR of 1.36 and 0.63, respectively. Similarly, administration of AC did not decrease overallrecurrence rate in comparison to obs. Conclusion: According to our results, AC (with or withoutradiotherapy) did not decrease recurrence rate in early stage uLMS; thus, the role of AC in this settingremains unclear.